whydo people go from place to place searching for help with their back pain? because85% of the time the cause of back pain is unknown!* what's missing?See below!

* Confirmed in Chou R, et al. Diagnoses and Treatment of Low Back Pain: A Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147:479.

What's missing

I find that back pain is most often the result of limited range of motion (loss of flexibility).

The limited range of motion causing the problem is not in the spine, rather it is elsewhere in the body. The person then uses their spine to do activity because they don’t have the range of motion required to do the activity properly. It is the spine doing activity it was not designed to do that can cause the back problems. I often find that people are completely unaware of their limitations and the impact of those limitations on their spine. This is true even when the limitations are huge (which is often the case).

I suspect that the extra activity the spine is doing is what eventually causes the degenerative changes, such as, arthritis, degenerative discs, herniated discs, and stenosis.

When people have pain at rest, such as, when sitting or standing, I find that they do not have the range of motion to get into the sitting or standing position. In this case their spine is forced out of its neutral position to achieve the sitting or standing position. Initially that can cause pain and eventually it can result in degenerative changes to the spine.

I strongly believe that people need to learn the specific limitations in their range of motion and then understand how that forces them to move from their spine during the activities that increase their pain.

I believe that the cause of back pain has been so elusive because each person has their own unique situation as a result of, (1) their own unique set of limitations, and (2) daily activities that are unique to them. Read more.

Steps You Can Take

You can take the following steps to find out if this is happening for you:


Describe your pain. The most important step is to identify the specific activities that increase your pain.

Start by noting if you have pain with activities when you bend, such as sitting or reaching down (activities that move your knees closer to your chest) or pain with activities when you are straight, such as standing, walking, or lying on your back with your legs out straight (activities that move your chest and knees further away from each other).

If you have pain when you bend and when you are straight then note if the pain with bending is different than the pain when you are straight. I find that pain with activities when straight tends to be more focused and sharper, whereas pain with bending tends to be broader, it can be intense however it is usually not as sharp.

To describe your pain you also need to identify the frequency, intensity and duration of your pain.

  • Frequency: How frequently does it happen? For example: All day, 25 percent of the day, 10x a day, 1x a day, every other day, 3x a week, or 1x a year during the spring season?
  • Intensity: What is it on a scale of 0-10? 0 is no pain, 10 is the worst pain.
  • Duration: How long does it last or how long does it take to come on? Measure of time is very helpful.

For example, you start to track your pain and find that each morning the pain is a 5 on a scale of 0-10 (or 5/10) after five minutes of standing. If you start a program to address your problems and you note that you now have a 3/10 after 25 minutes of standing you will be able to see the measurable improvement. This is important to help track which exercises are helpful so you can continue to further improve. I find that when people do not identify a measurable starting point they have difficulty seeing improvement and so they do not effectively learn what to do to help themselves.

Knowing the specific activities that increase your pain and the frequency, intensity and duration of your pain helps you control your pain. It also helps you develop a home program as you can most effectively track which activities/exercises increase your pain and which activities/exercises decrease your pain.

It is very difficult to describe pain; try not to get frustrated, just do your best. You can find help in Chapter 5 of the book Rescue Your Back.

Take this information to a physical therapist or physiotherapist.


Find a physical therapist who will take very specific range of motion measurements. The limitations in your range of motion reveal what your spine is forced to compensate for, therefore which measurements are taken and how they are taken is very important in identifying your problems. I often describe the problem as, the spine is the victim and the limited range of motion is the bully. We want to identify the specific bullies so we can most effectively address them.

I recommend range of motion measurements that focus on technique, particularly to have the spine as close to neutral as possible and not allow the spine to move during the measurement. (FYI initially the most pain free position of the spine is more important than being in the most neutral position.) A demonstration of each of the recommended range of motion measurements can be found in the PT Measurements Video.

Chapter 2 of Rescue Your Back discusses tolerance to the evaluation. If you have a lot of pain your body may not tolerate all of the measurements in the beginning. On the other hand, if you do not have very much pain you may tolerate all of the range motion measurements as well as motor control, postural alignment and strength testing during the initial evaluation.

Again I believe that you need to learn the specific limitations in your range of motion that produces the force on your spine during the specific activities that increases your pain.


Find a physical therapist or physiotherapist who will work with you on developing a daily home exercise program aimed at improving your range of motion and trunk stabilization first, then as tolerated your strength and postural alignment.

You also need to develop a plan of how to move through your daily activities and protect your spine as it takes a long time to make improvements in your range of motion.

Rescue Your Back is the vehicle I use to share more detailed information. It is a guide for you to use while you work with a physical therapist.

  • Chapter 5 helps you with a program to protect your spine now.
    It helps you describe your pain in measurable terms.
    It introduces the specific positions of the back and how to note if those positions increase and decrease your pain.
    It illustrates recommendations about how the activities that increase your pain, and/or the specific positions of your back that increase your pain, help identify positions to pursue and avoid as you move through the day.
    It outlines how to develop a Quick Relief Strategy to be able to decrease your pain on your own.
  • Chapter 6 shares information about how to develop an exercise program.
  • Chapter 7 illustrates the exercises that I tend to start with. They need to be tailored to each person's unique situation by a physical therapist.
  • Stories
    To enlarge the video, click the button in the lower right corner of the video to enter fullscreen viewing.
    ABike accident with subsequent neck and back pain for 8 years. Over time the pain became progressively worse.
    BHead and neck pain. X-ray revealed one vertebra shifted forward of the other vertebrae.
    CSports injury at age 18. Back pain started at age 30. The pain became worse over the next 20 years, impacting daily life and ability to sleep.
    D20 years of considerable pain in the neck, shoulders, back and feet. The pain significantly impacted daily life, even with continual treatment.
    ENeck and back pain. The pain became progressively worse, unable to tolerate sitting upright. Felt she had exhausted avenues of treatment.
    F15 years of back pain, progressively worse, ultimately unable to tolerate standing and sitting, reported feeling practically bed ridden.
    G18 months after an automobile accident the back pain was a 15/10; unable to do simple tasks.
    HConstant sciatic pain with episodes of extreme back pain. Never able to decrease pain on her own; access to prominent programs and physicians.
    IExtensive effort with body work; yoga and neuro-muscular techniques. Pain progressively worse; unaware of many mechanical problems.
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Cathy Mahon Physical Therapy
1610 West St, Suite 103
Annapolis, MD 21401

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About Cathy Mahon

Cathy Mahon, PT, MS has been practicing physical therapy for more than 32 years, receiving a MS in Physical Therapy from Boston University in 1986 and a BS in Kinesiology from the University of Maryland in 1983. Cathy acquired an expertise in orthopedics in the area of pain and dysfunction of the spine and extremities and has a private practice in Annapolis, Maryland which focuses on back pain.